A friend in her late forties mentions over coffee that she's started a testosterone cream. Another is sure her tiredness is "low T", because a checklist online said so. Somewhere between the two, testosterone has become one more hormone we're apparently meant to top up, sold with a lion on the label.
It is our hormone too, and it has been changing in our bodies for far longer than we'd guess. Yet the checklist may have the direction backwards, and the woman who needs to hear that is rarely the one buying the cream.
Where our testosterone comes from
Women make testosterone in three places. The ovaries make some, the adrenal glands make some, and a large share is built in fat and skin from raw materials the adrenals send out. The total is roughly a tenth to a twentieth of a man's, yet it's large next to our own oestrogen: by weight, a woman's blood carries more testosterone than oestrogen through her fertile years, and far more after menopause.
A good part of it is turned into oestrogen where it's needed, and much of what testosterone does for our bones, brain and blood vessels, it does in that form. The two work as a team, which makes testosterone a poor candidate for a separate dial to turn up.
What it does
The clearest job testosterone has in women is sexual desire. It feeds into the wanting, the responsiveness and the pleasure, and that's where changes in testosterone show up most reliably.
It also plays a part in keeping muscle and bone, and it seems to have a hand in energy, mood and focus. Those roles are harder to pin on testosterone alone, because oestrogen does much of the same work, so when a woman feels flat, weak and foggy, testosterone is one possible thread among many.
How levels change with age
Testosterone falls fastest in our twenties and thirties. By the early forties, a typical woman has around half the testosterone she had at twenty. The drop is gradual and steady, and it's mostly finished before menopause arrives.
Natural menopause itself brings no sudden fall. The ovaries keep making testosterone after periods stop, even as their oestrogen production winds down. Removing both ovaries in surgery is different, and women who've had that operation have noticeably lower levels.
So a woman who feels a sudden change at fifty is usually feeling the loss of oestrogen and progesterone. Testosterone has been sliding gradually for decades.
The symptom lists online
Search for low testosterone in women and you'll find long lists: tiredness, weight gain around the middle, brain fog, low mood, thinning hair. Almost every woman over forty ticks half of them, which is why they feel so convincing.
Two items on those lists have the direction wrong. Weight gain around the middle tends to go with higher testosterone in women, alongside insulin resistance. And thinning hair on the scalp is often linked to androgens, the family testosterone belongs to, so more testosterone tends to make it worse.
The tiredness, fog and low mood have commoner causes that come first: an underactive thyroid, low iron, poor sleep, long stress and perimenopause. Even for libido, a single blood test tells you little. When the sexual function of more than a thousand women was compared with their hormone levels, no single androgen level picked out the women with low desire.
The pill and your testosterone
Before blaming age, look in the bathroom cabinet. The combined contraceptive pill lowers testosterone in two ways at once. It quietens the ovaries, and it makes the liver produce more of a protein called SHBG, which binds testosterone and holds it out of action. On average, the free, active testosterone in women on the pill drops by more than half.
For many women that's welcome, and it's one reason the pill clears acne. Some notice their desire fading on it, and some find it slow to come back after stopping, a connection rarely mentioned when the pill is first handed over.
HRT can do the same. Oestrogen taken as a tablet passes through the liver first and pushes SHBG up, just as the pill does, while oestrogen through the skin, as a patch or gel, barely moves it. A woman whose desire dropped after starting HRT tablets has a lead worth raising when her treatment is reviewed.
When low testosterone matters
There is one situation where testosterone treatment has solid backing: a woman past menopause whose desire has dropped, and who is troubled by that change. When testosterone was compared with a dummy treatment in more than 8,000 women, it improved desire, arousal, pleasure and satisfaction, and reduced the distress that came with the problem.
The same results showed no clear benefit for mood, memory, muscle or bone, although fewer women were tested for those. The side effects were more acne and more hair on the face and body, and tablets raised LDL cholesterol where creams and gels left it alone, which is why skin treatments are preferred.
Treatment is prescription only and needs monitoring, with blood tests to keep levels within the normal range for a woman. In many countries, including the US and the UK, there's still no testosterone product made for women, so women are often given a small fraction of a product made for men.
Borrowing a partner's gel, or buying one online, is the quickest route to the side effects without the monitoring. A partner's gel can reach you without borrowing it, too: it rubs off skin to skin, and women and children have ended up with raised levels that way, so the gel needs to dry and stay covered. Pellets, small implants placed under the skin and popular in the US, release testosterone for months, often far above a woman's normal range, with no way to adjust them until they run out, which is why international guidance on testosterone for women advises against them.
DHEA and the "boosters"
DHEA, one of the adrenal raw materials the body turns into testosterone and oestrogen, is sold as a supplement in some countries. In women past menopause it has improved sexual function a little, left quality of life unchanged, and caused acne in some. Herbal testosterone boosters for women have even less behind them, and were usually tested, if at all, in men. DHEA, though, is a hormone, even when it sits next to the vitamins, and like any testosterone top-up it can push levels too high.
Too much: the problem with a name
Too much testosterone is a common, well-understood problem, and the usual reason is polycystic ovary syndrome, or PCOS, which affects around one woman in ten. Its signs are irregular or missing periods, acne along the jaw and chin, dark coarse hair on the face, chest or stomach, and thinning hair on the scalp. Many women with PCOS also find weight gathers around the middle and becomes stubborn to shift, and anxiety and low mood are more common with it too.
PCOS is also the most common reason a woman stops ovulating regularly, which makes it one of the leading causes of trouble getting pregnant. The encouraging part is that ovulation often returns once weight and insulin come down, sometimes within a few months, and insulin is the part you can steer.
The condition is often missed for years, because each sign on its own gets treated separately: the acne by one route, the periods by another, the weight with a diet. Seen together, they point at the same hormone.
Getting it named is simpler than many women expect. PCOS is recognised when two of three things line up: periods that come irregularly or stop, signs of too much testosterone on your skin or in a blood test, and ovaries crowded with small follicles, seen on a scan or, in adults, through a blood test called AMH. On the screen, those follicles sit around the edge of the ovary like a string of pearls: eggs that stalled on the way to being released, and a long way from the cysts the name suggests. The easiest evidence to gather is your own: note each period on your phone for a few months, and "they're a bit all over the place" becomes a pattern anyone can see.
Less often, a medication, a supplement or something more serious is behind it. Signs that appear suddenly and build over a few months, such as rapid hair growth on the face and body, a deepening voice or an enlarging clitoris, need checking promptly.
Insulin, the lever you can pull
Insulin is the part of the story that sits in your hands. When it runs high, it tells the ovaries to make more testosterone, and it tells the liver to make less SHBG, so more of that testosterone is free and active. High insulin pushes testosterone up from both ends at once.
A diet heavy in sugar, flour and other fast carbohydrates keeps insulin high through the day. Eating fewer of them, losing weight around the middle if you're carrying it, and building muscle, which soaks up blood sugar, brings testosterone down with it.
Slim women get PCOS too, and theirs is the version that's easiest to miss, because nothing on the scales hints at it. Many of them carry the same insulin resistance underneath, so the same changes work for them: fewer fast carbohydrates and more muscle act on insulin directly, with or without a pound to lose. Inositol, a vitamin-like supplement popular for PCOS, has helped some blood sugar measures and possibly ovulation, and little else. Food and muscle do far more.
The same insulin resistance also raises the risk of type 2 diabetes later in life, so the habits that bring testosterone down are also protecting your long-term health. An HbA1c test shows your average blood sugar over the past two to three months, and an lets you check it from a finger-prick every so often. Sleep belongs here too. A few short nights are enough to make insulin work less well, and sleep apnoea, where breathing stops and starts through the night, is more common in PCOS, so mention loud snoring or heavy daytime tiredness when you get checked.
What keto and carnivore eating offers here
Ketogenic diets, which cut carbohydrates to a minimum, have been tried in women with PCOS, and after six weeks or more the pattern was consistent: free testosterone fell, SHBG rose, and weight came down in every group tested. The groups so far are small and the diets short, so this is a promising lead with more still to learn.
A carnivore diet takes the same idea further, with meat, fish and eggs and almost no carbohydrate at all, so insulin stays low all day. Nobody has tested it on its own in PCOS yet, though it pulls the same lever. For a woman with PCOS who is ready to change how she eats, cutting carbohydrates hard is one of the most direct ways to bring her testosterone down. is written for her, and it walks through the insulin side of PCOS and how eating and fasting can bring it back under control.
Cutting carbohydrates is a different thing from cutting food. Women who diet or train hard on too little can slow their whole hormone system, periods included, so plenty of protein and fat keeps it running. And the "testosterone foods" lists online are borrowed from men's health: no food has been shown to raise testosterone in women.
The hair on your chin
Those few dark hairs on the chin or upper lip are the sign women tend to hide, and the old warning about shaving is the first thing to drop. A shaved hair grows back with a blunt tip that can feel stubbly, and the hair itself returns no thicker, darker or faster than before. Plucking, threading, waxing and shaving all keep it in check, and laser and electrolysis thin it for the long term, laser working best on dark hair against lighter skin.
Spearmint tea is the pleasant surprise. In a small group of women with PCOS, a month of drinking it lowered both free and total testosterone, and the women felt less hairy, although measured hair growth was still unchanged at that point. That fits, because hair is the slowest sign to answer. Each hair grows through a cycle lasting months, so it can take half a year after insulin and testosterone come down to notice fewer, long after periods and skin have settled. The change comes, and it comes last.
Strength without the hormone
Much of what people hope testosterone will do for a woman, stronger muscles, firmer bones, more energy, comes straight from strength training, whatever your testosterone level, and the same work makes insulin work better. A pair of lets you start light at home and add weight as you get stronger, with no gym needed.
Plenty of us worry about bulking up, and a woman's naturally modest testosterone is the reason that rarely happens. What you get instead shows up in carrying the shopping, climbing the stairs and staying steady on your feet for years to come.
Testing, and what it can tell you
A blood test for testosterone earns its keep spotting levels that are too high and keeping levels in range during treatment. It's poor at diagnosing low testosterone: there's no agreed cut-off, levels shift through the month and the day, and many standard tests are inaccurate at a woman's low levels.
If you do get tested, ask for testosterone and SHBG together, in the morning, because SHBG decides how much of your testosterone is free to work. Our guide to hormone tests, linked below, goes through what to ask for and when.
Knowing which way to look
So the checklist had it backwards where it matters. The belly weight and thinning hair it blames on too little testosterone point to too much, and the woman who needs this is the one with irregular periods, a few new chin hairs and a waistline that stays stubborn, who may never have been offered a testosterone test at all. For her, the lever is insulin, and food, sleep and strength pull it harder than any cream. The friend with the cream may be right too, if she's past menopause and her desire has gone quiet. That's the one place a top-up has earned.
If your periods have gone irregular and your skin or hair has changed, put those signs side by side and ask for testosterone and SHBG together, in the morning. And whatever your numbers say, two strength sessions a week will give you more of what the lion on the label promises than anything in the bottle.
Wondering which hormone tests to ask for? Hormone Tests Worth Asking For: A Woman's Guide — how to match the right test to your symptoms, what skews the results, and how to walk in prepared.
Feeling off and suspect more than one hormone? The Hidden Signs of Hormone Imbalance, and How to Test for Them Properly — how stress, blood sugar, oestrogen and thyroid pull on each other, and what helps in which order.
Know a woman who's been told her tiredness is "low T"? Send her this. The answer might be pointing the other way.
Disclaimer: This article is general information. For advice about your own health, talk to a qualified health professional. If your periods change, hair appears suddenly on your face or body, or your voice deepens, get it checked promptly.
Affiliate Disclosure: This article contains affiliate links. As an Amazon Associate, All For Life earns from qualifying purchases, at no extra cost to you. We only link to products we would recommend without the commission.